A prescription for failure: Why veteran suicide rates aren’t dropping

According to a study conducted in the past year by the Department of Veterans Affairs, the oft quoted “twenty-two veteran suicides per day” figure isn’t quite accurate. The actual figure is twenty, which is objectively no less concerning. The real horrifying figure in that study, however, was that roughly sixty percent of the veterans that take their own lives each day are regular users of VA services.

This statistic raises serious questions about the treatment veterans are receiving for Post-Traumatic Stress, depression and anxiety, but those questions may not all be fairly directed at the VA themselves. That VA study concluded that, while veteran suicides have increased in recent decades, suicides among civilians have as well. An adult American civilian in 2014 was twenty-three percent more likely to commit suicide than they were in 2001. While this number is smaller than the veteran statistic (at thirty-two percent) it is still indicative of a mental health issue in the United States that extends beyond those of us that spent time in uniform.

A number of recent studies have shown that anti-depressants, the most commonly prescribed course of treatment for PTSD and depression, may not be very effective at managing or reversing the negative emotional effects of the illness. In fact, often anti-depressants score only slightly better than placebos in clinical trials. Combine this poor rate of effectiveness with the comparably high rate of adverse side effects, and the suicide rates among those being treated for depression begin to make sense.

The most common side effects among those being treated with anti-depressants are sexual dysfunction and weight gain. While seemingly trivial, compounding these issues in the life of a veteran that is already struggling with depression for the sake of a medication that may not actually be helping serves to exacerbate the situation rather than remedy it. The pills these men and women take to get better, often make things worse. Weight gain and sexual dysfunction can negatively affect the relationships of those seeking treatment, weakening support structures and increasing the likelihood of a suicide attempt.

Within the medical industry, a fierce debate is raging over the effectiveness of the medications used to treat PTSD and depression. Unfortunately, there have been a number of studies that back up both assertions. How is it possible that two camps within the same industry, working with the same medications and often even the same facts can come to two completely different conclusions? In September, a study published in the medical journal PLOS set out to determine exactly that. What they found was that clinical studies that emphasize the negative side effects of anti-depressants are often not published, whereas studies that indicated a positive outcome for the prescription of these drugs met a much higher publication rate. In effect, the studies that argue against contemporary thinking on the topic often go ignored or under reported.

Recent clinical studies have shown that, even among the severely depressed, most anti-depressant medications have a negligible effect on many patients. Using a test commonly referred to as the Hamilton Rating Scale, physicians rated patient’s levels of depression using a point scale, with a score of eighteen or higher indicating severe depression. The patients were then given either a common anti-depressant medication or a placebo. In order for the medication to produce a clinically significant improvement in the mental health of the patient, the anti-depressant prescribed patients would need to indicate an improvement on the Hamilton scale of at least three points over the placebo.

The study concluded, however, that the patients taking anti-depressants scored only 1.8 points better than those taking a sugar pill when tested again after treatment. While this does indicate that the pills work better than the placebo, the difference is so slight that it fails to qualify as clinically significant. The medication may indeed be helping, but so little that its effects may still fall within the scope of the infamous placebo margin. It’s important to note, however, that those suffering from the most extreme forms of depression did see a larger effect from the medication than the average patient.

Anti-depressants may indeed help, but clinical studies suggest that they are not as effective as they would need to be to produce a measurable benefit if the lives of the ever-growing number of veterans they are prescribed to. The VA, for all its faults, may not be entirely to blame for the sixty percent of veteran suicides that occur on their watch; without effective treatment options, suicide rates will not diminish. The side effects many veterans experience as a result of the medications only make the situation ever more difficult to resolve.

With all of these problems and so few solutions, the prognosis for America’s veteran community that suffers from PTSD or depression seems grim. If the medications we prescribe are hardly helping, what else can we do to curb suicide rates? The answer, according to the American Psychological Association would seem to be therapy. Studies have shown that psychotherapy produces better long term results and leads to fewer relapses than the use of medication alone, and the two working in conjunction with one another offers even better results.

The issue with providing increased therapy services to the community of veterans that are suffering from PTSD can be seen by any veteran that has ever visited a doctor at their local VA Medical Center. If you come in seeking treatment for your depression, you will likely spend a few short minutes speaking to a physician before receiving a prescription and being sent on your way. Providing hours of counseling to each patient that currently takes anti-depressants would require a dramatic shift in the way in which care is delivered, and would certainly increase costs in terms of staff and facilities.

Because the medical community is currently torn on the topic of the effectiveness of anti-depressants, it seems unlikely that the federal government will choose the side that requires a dramatic increase in funding and restructuring of treatment methodology. With so much disagreement among medical professionals, it would be difficult to blame them.

As a veteran, I’ve lost more friends to suicide than I have to combat. The uncertainty surrounding the effectiveness of anti-depressant medications came as a total surprise to me, as it likely will to many of you, but upon further thought, it makes a bit of sense. If the medications prescribed for depression were as effective as an antibiotic is at combating bacteria, the suicide statistics would likely have dropped dramatically in recent years, as more and more people were prescribed them. If medication could prevent suicide, the government would likely prescribe it to every separating service member, just as they do to prevent things like malaria when military personnel return from deployments.

Until the medical community is able to make an absolute determination on the proper course of treatment for our brothers and sisters in arms struggling with their demons, we’ll likely continue to lose twenty of them a day. Studies suggest that therapy and medication together can produce real results, but that will require a shift in cultural perceptions about depression: no longer can we think of it as an illness we can cure with a handful of pills. It turns out, speaking to someone may still be the best option to treat PTSD and depression.

In the meantime, I urge veterans to reach out to your old fire team. Call your buddies or shoot them a message on Facebook. Make sure they’re doing all right, and if they’re not, let them know that you’re there and are willing to help. The United States Armed Forces are the best in the world, in no small part because we look out for our own. Take care of your brothers and sisters, and let them take care of you.

If you are having difficulty with depression and fear you may harm yourself or others, please reach out for help. Below is a list of organizations that can help you overcome the hurt and start the healing process. Remember, speaking to someone is still the best way to get better.

About the Author

About Alex Hollings

Alex Hollings writes on a breadth of subjects ranging from fitness to foreign policy, all presented through the lens of his experiences as a U.S. Marine, athlete and scholar. A football player, rugby player and fighter, Hollings has spent the better part of his adult life competing in some of the most physically demanding sports on the planet. Hollings possesses a master's degree in communications from Southern New Hampshire University, as well as a bachelor's degree in Corporate and Organizational Communications from Framingham State University.

BECAUSE, FACTS DON'T TAKE SIDES

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Eric Burleson

It turns out the there are both chemical and physiological (i.e. structural) conditions of the brain that can cause depression. Additionally, you can actually alter the structure of the brain with psychotherapy and group work. it seems evident to me that the one may be able to overcome depression with therapy alone, or with therapy aided by medication, but almost never by medication alone.

Jerry Sullivan

What a righteous thing for your father to do for those lost souls. Sometimes a quiet place away from the maddening pace and noise of modern civilization was all that was needed. I certainly cherished the great forests of the Rocky Mountains and the Black Hills of South Dakota. Thanks Micky!! Blessings my friend... Jerry

Micky M

It is heart breaking. My father was a farmer, and during the late 60's we would often find Vietnam Vererans camping out on his farm land. He would fill the large milk cans with water so that they wouldn't drink from the streams and rivers which were polluted. We didn't have a lot of money but food on the farm was abundant so no one went hungry. Some stayed for a few days and a few stayed for a year or more. I don't think any of the Vets I met back then on the farm were receiving benefits or treatment. Most traveled on foot hitchhiking from here to there. I agree that it is the personal interaction, kindness, caring and love that helps. Adding a 4 legged friend is icing on the cake.

David P

My experience is that meds and thoughtful therapy work best. I've had therapists that don't know how to navigate your trauma, only to send you out into the world after a session worse than when you came in. I struggled for years until almost losing everything, then finally found the right doctor. He's heard my story and understands that it is not safe to unpack the trauma until skills are in place to deal with the emotions and distress. I highly recommend Dialectical Behavioral Therapy (DBT) as the first step in building that tool kit. If you only do weekly group sessions it can be affordable, but you do need additional coaching/debriefing on how you applied the skills in the real world.
I'm also a big fan of EMDR, which is an intense trip. I won't go into the details on that, unless someone is interested, but you re-experience the trauma, so, again, a therapist and DBT are necessary, IMHO.
A buddy with severe PTSD and TBI is having a really tough go of it, only made worse by the damage of repeated unsuccessful attempts at taking his life. I'm frustrated with the lack of proper care he has/is receiving (meds and no therapy) and have taken to trying to provide for him. Keeping my fingers crossed, as we're half a continent away.
And yes, the dysfunction and weight gain side-effects suck.
Dave

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